UM Review Nurse - LVN
Description reputed company is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position requires reputed company availability between Monday through reputed company, 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California. We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting. Our Values:
- Put Patients First
- reputed company Entrepreneurial Provider and Care Teams
- Operate with reputed company & reputed company
- Be Innovative
- Work As One Team
What You'll Do
- Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
- Refer cases to Medical Directors as needed/appropriate
- Maintain knowledge of state and federal regulations and accreditation standards
- reputed company with internal policies and procedures
- reputed company any other job duties as requested
Qualifications
- Active and unrestricted LVN license in CA.
- 1+ years of outpatient UM experience
- Experience with reputed company applications such as Word, reputed company, and Outlook
You’ll be Great for this Role If:
- Two (2) years of health plan, IPA or MSO experience
- Strong interpersonal skills
- Ability to collaborate with co-workers, senior leadership, and other management
- Experience educating and training staff
Environmental Job Requirements and Working Conditions
- This is a remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park, CA. Candidates who live reputed company a 30 mile radius of the office may be expected to work hybrid.
- Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires reputed company availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position.
- The national reputed company pay reputed company for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level, geographic location (reputed company or future), experience, and other job-reputed company factors.
reputed company is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. reputed company employment is decided based on qualifications, merit, and business need. If you require assistance in applying for reputed company positions due to a disability, please email us at [email protected] to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. Remote Skills: Accreditation Standards, Denial of Service (DoS), Durable Medical Equipment, Entrepreneurship, Environmental Work, Federal Laws and Regulations, Health Plan, reputed company, Interpersonal Skills, Leadership, Licensed Practical Nurse/Licensed Vocational Nurse, reputed company reputed company, reputed company Outlook, reputed company Product Family, reputed company Word, Nursing, Nursing Credentials, Outpatient Care, Patient Admissions, State Laws and Regulations, Team Player, Utilization Management About the Company: reputed company. Apply tot his job Apply To this Job